But they\nwere going to do their best to make good on tomorrow, too.<\/p>\n\n\n\n
That was the motivation for 82 participants in a study that looked at how physical activity helped Native American cancer survivors to heal, recover and find a healthy lifestyle. The study, which was part of the Partnership for Native American Cancer Prevention (NACP), was a collaborative effort between Northern Arizona University and the University of Arizona Cancer Center. Researchers looked at whether a program that included weekly exercise sessions with a trainer, combined with a home exercise program and regular health monitoring, could help the group become healthier.<\/p>\n\n\n\n
The project\nended Aug. 31, so it\u2019s too soon to officially say yes, it does, but\nanecdotally\u2014yes, it did. <\/p>\n\n\n\n
\u201cWhat\nwe\u2019re finding is just movement itself is rehabilitative,\u201d said Brenda\nCharley<\/strong>, coordinator of the project. \u201cThat\u2019s one reason we let friends and\nfamily in. We want to make sure they understand they\u2019re doing something good\nfor themselves too.\u201d<\/p>\n\n\n\n The\nproject focused on Navajo cancer survivors and their caregivers and Native\nAmerican, mostly Navajo personal trainers\u2014getting them valuable experience and\npreparing for certification to send them back to their communities with the\nskills needed to continue in this work. <\/p>\n\n\n\n The\nneed for this research<\/strong><\/p>\n\n\n\n For a long\ntime, medical research tended to treat everyone as a monolith, not taking race,\ngender and other demographic factors into account. As a result, Native\nAmericans\u2019 unique needs were overlooked. Dirk de Heer<\/strong>, an associate\nprofessor of health sciences and principal investigator in the NACP, looked for\nholistic ways to fill that research gap that not only focused on Native\nAmericans\u2019 health but also met the research subjects where they were, leaving\nspace for tradition as they worked out and tracked calories. If that meant\nwearing a Fitbit with ceremonial dress, then that\u2019s what they did.<\/p>\n\n\n\n \u201cThere is\nan enormous need for translational research with the Navajo Nation and other\ntribal nations in our region,\u201d de Heer said. \u201cPeople often travel very far to receive\ncare and screening, not to mention the additional barriers related to poverty\nand cultural misalignment in our health care system. Even more importantly,\nthere is a need to train local personnel, support workforce development and\nwork directly with regional providers.\u201d<\/p>\n\n\n\n This gap is largely what the NACP was created to address; all of the associated researchers are asking cancer questions about Native populations. In 2013, the program sent out a call for pilot proposals on which NAU and U of A researchers collaborated. De Heer received recommendations from now-provost Diane Stearns<\/strong>, who was the NACP research lead at the time, and connected with NAU nursing professor Anna Schwartz <\/strong>and Jennifer Bea, a cancer exercise and body composition researcher at U of A. Etta Yazzie, an oncology nurse Arizona Oncology Associates, also joined the team as one of the few oncology providers in the region with in-depth knowledge of the Native American culture. Jointly, they developed a project aimed at Native American cancer survivors and how physical activity could help them live longer, healthier lives. <\/p>\n\n\n\n After the\nfirst round of research, they received funding for a five-year project and took\non more partners, including the Native Americans for Community Action (NACA),\nthe Leupp Chapter, research specialist Taylor Lane<\/strong>, now a Ph.D. student\nin interdisciplinary health at NAU, and several Native American students from\nboth NAU and U of A, including Gold Axe winner Shelby Dalgai<\/strong>, Agassiz\nWriting Award winner Kaitlyn Haskie<\/strong>, former Miss Indigenous NAU Jayme\nBiakeddy<\/strong> and many others.<\/p>\n\n\n\n The focus\ngroup phase aimed at understanding barriers and facilitators to physical\nactivity among cancer survivors. It was followed by a pilot study where the\nresearchers developed and tested a physical activity intervention for cancer\nsurvivors. It started in Flagstaff and Leupp, but the researchers realized\nquickly that traveling further reduced clients\u2019 likelihood of success, so they\nopened clinics in Tuba City and Winslow as well. They also realized Native\nAmericans, who place a high value on family and community support, did better\nwith access to that support, so the team expanded the study to include\ncaregivers.<\/p>\n\n\n\n \u201cThis is\nincredibly important in the Native American culture and history of kinship,\u201d de\nHeer said. \u201cIn addition, family members of cancer survivors are often\nthemselves at higher risk of developing cancer, which makes a physical activity\nprogram an important preventive measure.\u201d<\/p>\n\n\n\n The\nresults bore out that early observation, he said; patients who participated\nwith family members had increased motivation and adherence to the protocol as\nwell as an easier time with logistics like getting to the training center.<\/p>\n\n\n\n Each\nparticipant signed up for an 18-week period. For 12 weeks, they would meet once\na week with a trainer, talk about their progress, set goals, work through\nchallenges and then get an exercise regimen for the next week. That regimen\nusually consisted of a certain number of minutes of cardio and several strength-training\nexercises that used body weight or resistance bands or pulled \u201cweights\u201d from\nthe average person\u2019s home, like soup can rows.<\/p>\n\n\n\n The\nparticipants also had a six-week period, either before they started the weekly\nsessions or after, where they were still providing data but not actively\nmeeting with a trainer. Each participant had measurements, including weight,\nwaist and hip size, A1C blood tests, blood pressure and other indicators taken\nat the start of the project and at six weeks, 12 weeks and 18 weeks.<\/p>\n\n\n\n The\ntrainers also explained what those data meant, Charley said; often, patients\ndidn\u2019t know what an A1C reading was and whether their number was good or\nworrisome. (It\u2019s a test that measures blood sugar and is used to diagnose Type\n2 diabetes and prediabetes.)<\/p>\n\n\n\n It wasn\u2019t\nalways easy; Charley said technological issues like Fitbits simply not working\non the reservation required the team to shift methodology as they went,\nresorting to questionnaires to gather information about food intake and how many\nminutes worked. And even the questionnaires weren\u2019t all that effective; she\nfound that most of the participants wrote little information down, but they\nwere happy to sit down with her or a trainer and talk about what they\u2019d done\nthat week.<\/p>\n\n\n\n Although\nthe trainers worked directly with clients, they had a conference call once a\nweek with de Heer, Yazzie, Bea, Schwartz, Lane and Charley, discussing each\nclient in-depth. The trainer working with each individual would explain that\nperson\u2019s progress and challenges, the regimen they\u2019d just finished and the\nupcoming regimen they were considering. The experts would weigh in, making\ntweaks and providing direction as needed.<\/p>\n\n\n\n Finding\nNative solutions<\/strong><\/p>\n\n\n\n Much of\nthe motivation behind this study was to examine the beliefs and knowledge of\nNative Americans related to cancer, physical activity and treatment and then to\nturn around and use that knowledge to provide treatment that was in keeping\nwith Native culture while also offering the best medical care possible.<\/p>\n\n\n\n A major\ncomponent of this is the personal trainers themselves, who coached participants\nthrough exercises, talked to them about how they were feeling and explained how\nthey might not have lost weight, but they lost inches and gained skeletal\nmuscle and that\u2019s even better. Because all of the trainers were Native, they\nunderstood the traditions and the prayers and the directions from a medicine\nman. When a client came in having just done a ceremony, wearing ceremonial\nclothing and unable to do certain tasks, the trainers took it in stride and\nworked around those limitations. Once, McClellan conducted client sessions in\nceremonial dress. No explanation was needed.<\/p>\n\n\n\n \u201cWe had to\nbe creative in not letting them feel uncomfortable because they came dressed\nthe way they were, with those kinds of limitations,\u201d Charley said.<\/p>\n\n\n\n The mutual\nunderstanding of tribal traditions and belief made these training gyms a safe\nplace for clients. Although it\u2019s too soon to know the data, anecdotally, the\ntrainers said they saw differences. They saw commitment and desire and\nunderstanding. <\/p>\n\n\n\n \u201cMany of\nthem haven\u2019t exercised because they don\u2019t know what good exercise feels like,\nwhat movement can do for them mentally, physically and emotionally,\u201d Charley\nsaid. \u201cOr they forgot. A lot of them talk about their childhood, how they used\nto run all the time and be out playing, then they grew up and forgot how to do\nthose things. Our job is to connect them back to it.\u201d<\/p>\n\n\n\n The\ntrainers are more than happy to be that link. Pedwaydon, who is of the Ottawa,\nChippewa and Delaware tribes, is a cancer survivor. He talks about how his\nuncle, a medicine man, told him not to pound the earth or he risked the cancer\nreturning. Pedwaydon put his snowboard away forever. <\/p>\n\n\n\n \u201cCancer\nsucks,\u201d he said, to nods from his fellow trainers. \u201cTo see these individuals\nwho are patients\u2014survivors\u2014trying to help themselves, and this is a new concept\nfor them, that exercise is medicine. And guess what? You need medicine.\u201d<\/p>\n\n\n\n One\nmemorable day western and Native medicine collided for Pedwaydon. One of his\nclients showed up with a small bag. They walked through the PT routine, and the\nman kept the bag close, shifting it around as he performed the exercises. <\/p>\n\n\n\n Finally,\nPedwaydon asked him what was in the bag.<\/p>\n\n\n\n \u201cThat\u2019s my\nmedicine,\u201d the client said matter-of-factly. \u201cIt\u2019s my chemo.\u201d<\/p>\n\n\n\n For\nMcClellan, who is Navajo, the difference is more than physical. She watched\npatients watch out with greater confidence in themselves and their ability to\nheal and become stronger.<\/p>\n\n\n\n \u201cThey\nstart to live it, is what they do,\u201d she said. \u201cWe assign their at-home\nprograms, and they try to implement it in their lives. And most of them did!\nThey applied it in their lives.\u201d<\/p>\n\n\n\n \u201cThat\u2019s\nwhere you guys come in,\u201d said Anthony Santos<\/strong> with a nod. Santos, a\nsecond-year Ph.D. student in the interdisciplinary health program, oversees the\ntrainers, including helping them study for the ACSM certification. \u201cYou can\ntravel all over the Navajo Nation and can confidently educate and push people\ntoward a healthier lifestyle. You can be a true service to the Navajo people\nfor sure.\u201d<\/p>\n\n\n\n That\u2019s\nalso what de Heer and his collaborators envisioned when the program started.\nIt\u2019s why they\u2014a team of certified, highly qualified health professionals\u2014are\nnot on the ground working with clinics. Preparing the trainers for continued\nwork with Native people after the study has ended is a critical outcome.<\/p>\n\n\n\n \u201cLocal\ntrainers and workforce development are incredibly important for sustainability\nof everything we try to do,\u201d de Heer said. \u201cThey live in the communities we\nwork in, and supporting their career development is as important as our\nintervention. The knowledge and experience they build will carry on and\ncontinue to help their communities.\u201d<\/p>\n\n\n\n Results\nand next steps<\/strong><\/p>\n\n\n\n At this\npoint, they\u2019re preliminary, but the data show positive trends in weight loss at\nsix weeks and fitness and quality of life at 12 weeks. Plus, patients just\nreported feeling better, with more energy and more excitement for life.<\/p>\n\n\n\n The team\nwill continue studying the data, looking at possible next steps in approaching\nNative Americans\u2019 approach to cancer care. The findings for this study will be\npresented at the Navajo Human Research Review Board Conference in October and\nthe American Association for Cancer Research on Cancer Health Disparities in\nSeptember.<\/p>\n\n\n\n Besides\nthe benefits to cancer research, students who participated in this program also\nsaw benefits. Many Native American students have gone on to medical school,\ngraduate programs in public health and completed internships and fellowships at\norganizations like the National Institutes of Health and Harvard. De Heer said,\nin addition to the NACP (which is funded in part by the NIH), donations from\nthe John and Sophie Ottens Foundation made such internships possible.<\/p>\n\n\n\n \u201cIt is my\nhope that these students will not only support but lead many projects in their\nown communities in the future that address the needs of cancer survivors and\ntheir families,\u201d de Heer said.<\/p>\n\n\n\n![\"\"](\"http:\/\/in.nau.edu\/news\/wordpresst\/uploads\/sites\/153\/wp-content\/uploads\/2019\/09\/4698_restoring_balance_20190130-684x1024.jpeg\")
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Heidi Toth | NAU Communications
(928) 523-8737 | heidi.toth@nau.edu<\/a><\/p>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"